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CLINICAL STUDY

Long-term follow-up of right ventricular monomorphic extrasystoles

Fiorenzo Gaita, MD^*, Carla Giustetto, MD, Paolo Di Donna, MD^*, Elena Richiardi, MD^*, Luigi Libero, MD, Maria C. Rosa Brusin, MD, Giuseppe Molinari, MD^* and Giampaolo Trevi, MD

^* Department of Cardiology of the Civil Hospital of Asti, Asti, Italy
University of Torino, Torino, Italy

Manuscript received November 21, 2000; revised manuscript received April 13, 2001, accepted April 26, 2001.

Reprint requests and correspondence: Dr. Fiorenzo Gaita, Divisione di Cardiologia, Ospedale Civile, Via Botallo, 4-14100 Asti, Italy
gaitaf{at}tin.it

OBJECTIVES

The purpose of this study was to verify in a long-term follow-up whether frequent monomorphic right ventricle extrasystoles may progress to arrhythmogenic right ventricular dysplasia (ARVD).

BACKGROUND

Frequent monomorphic right ventricle extrasystoles are generally considered benign. However, in patients with this pattern, cardiac magnetic resonance (MR) has recently shown anatomical and functional abnormalities of the right ventricle.

METHODS

Sixty-one patients who had been classified by noninvasive examinations as having frequent idiopathic right ventricle ectopy were contacted after 15 ± 2 years (12 to 20) and submitted to clinical examination, electrocardiogram (ECG), Holter monitoring, stress test, signal averaged ECG, echocardiography and, in 11 patients, cardiac MR. The primary end point was to ascertain the presence of cases of sudden death or progression to ARVD.

RESULTS

At the end of the follow-up, 55 patients were alive; six died, none of sudden death; eight stated to be well but refused further examinations. The 47 patients examined had normal ECG; in 24 patients (51%), extrasystoles were no longer present at Holter monitoring; late potentials were present in up to 15% of the patients; the right ventricle was normal at echocardiography. In 8 of 11 patients (73%), cardiac MR showed focal fatty replacement and other abnormalities of the right ventricle.

CONCLUSIONS

In this long-term follow-up study, no patient died of sudden death nor developed ARVD; two-thirds of the patients were asymptomatic, and, in half of the patients, ectopy had disappeared. Focal fatty replacement in the right ventricle was present in most.

Abbreviations and Acronyms   ARVD = arrhythmogenic right ventricular dysplasia   ECG = electrocardiogram   LBBB = left bundle branch block   MI = myocardial infarction   MR = magnetic resonance   RBBB = right bundle branch block   SAECG = signal averaged electrocardiogram

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